The Effect of Delayed Surgery in Adult Patients with Acute Appendicitis

PURPOSE: There are many reports that delayed operation of appendicitis in children is safe, but it is controversial whether the same principle can be applicable in adult patients. The aim of this study was to evaluate the relationship between the interval from onset of symptoms to operation and the pathologic degree of appendicitis. METHODS: In this retrospective study, 783 adult patients (16 years old or more) diagnosed with appendicitis pathologically between 2004 and 2007 were included. The time from onset of symptoms to hospital arrival (patient interval) and time from hospital arrival to operation (hospital interval) were investigated. Pathologic and gross state of the appendicitis was graded as G1 (suppurative), G2 (gangrenous), G3 (ruptured), G4 (periappendiceal abscess). RESULTS: The median time from symptom onset to operation (total interval) was 35 hours. The percentage of G1, G2, G3, and G4 was 86.3%, 11.4%, 2.4%, and 0% when total interval was <24 hours, 61.3%, 21.3%, 15.8%, and 1.6% when between 24 and 72 hours, and 23.8%, 13.9%, 36.9%, and 25.4% when the interval was over 72 hours. The advanced grade of appendicitis correlated with increased hospital stay (P<0.0001). CONCLUSION: This study suggests that delayed appendectomy in acute appendicitis in adults is a risk factor for advanced grades, and that the sooner the operation is undertaken, the better the outcome is.

Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m Tetrofosmin according to ROC Curve Analysis for Breast Cancer / 한국유방암학회지

PURPOSE: Tc-99m Tetrofosmin is a new alternative to Tc- 99m MIBI for nuclear breast imaging. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the feasibility of Tc-99m Tetrofosmin quantitative scintimammography (SMM) (qSMM) and to compare with previously reported Tc-99m MIBI qSMM data [J Kor Surg 1999;57(5):638-644)]. METHODS: Prone anterior, lateral planar and supine SPECT images were taken from 135 cases in 131 female patients (mean ages=44 yr) with breast mass (size> or =0.2 cm) after 30mCi intravenous injection of Tc-99m Tetrofosmin. 70 malignant and 65 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: the Lesion (L), the Normal breast opposite the lesion (NL) and the right Chest wall (CW). L/NL and L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that the planar L/NL ratio and the SPECT L/NL and L/CW ratios had higher diagnostic accuracy for detecting breast cancer than he planar L/CW ratio did (P<0.05). The qSMM (mean), which is an arithmetic mean of the planar L/NL ratio, the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, accuracy and area under curve (AUC) were 82.9%, 81.5%, 82.2% and 0.879 respectively. Presence of axillary lymph node metastasis showed a slightly higher qSMM (mean) value (2.79 {n=23} vs 2.75 {n=27} P=0.06). These are comparable with previously reported Tc-99m MIBI qSMM data of 84.4%, 76.6%, 81.0% and 0.847 respectively, and the presence of axillary lymph node metastasis showed a higher qSMM(mean) value (4.09 {n=17} vs 3.09 {n=28}, P=0.06) [J Kor Surg 1999; 57(5):638-644)]. CONCLUSION: Tc-99m Tetrofosmin qSMM (mean) is a useful and objective method for differentiating malignant from benign breast lesion and has the comparable diagnostic accuracies of Tc-99m MIBI qSMM.

Clinical Analysis of Phyllodes Tumor of the Breast / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Phyllodes tumors are fibroepithelial mammary lesions that tend to behave in a benign fashion but may undergo sarcomatous transformation. They account for 0.3 to 0.5 percent of all breast tumors. Their behavior is not well understood by many clinicians. MATERIALS AND METHODS: We retrospectively reviewed the clinical, radiologic, and pathologic finding and treatment modality of 31 patients of phyllodes tumor diagnosed at the Breast Clinic, Gachon Medical School Gil Medical Center between July 1992 and July 2000. RESULTS: Pathologically, 6 patients (19.3%) had malignant tumor and 25 patients (80.7%) had benign lesions. All were women with average age of 36 years. The patients with malignant tumors tended to be older and had larger tumors and shorter duration. For preoperative diagnosis, we used mammography, sonography, and MIBI Scintimammography, fine needle aspiration cytology and biopsy. All these diagnostic methods suggested the diagnosis of phyllodes tumors in only 8 cases (26%). All patients received surgical treatment: excision in 21 cases, wide excision in 3 cases, simple mastectomy in 5 cases, and simple mastectomy with axillary lymph node dissection 2 cases. One patient with malignant tumor, two patients with borderline tumor and three patients with benign tumor experienced recurrence (19.3%). CONCLUSION: None of the clinical or radiologic characteristics was useful in predicting for phyllodes tumor. Phyllodes tumors were difficult to make proper preoperative diagnoses and to differ malignant tumor from a benign one. This led to a simple excision and resulted in high local recurrence. We suggest that the initial or subsequent wide excision is an appropriate surgery to decrease the recurrence.

The Treatment of Adhesive Small Bowel Obstruction in Children

BACKGROUND: Immediate operative management has been applied to infants and children with an attacks of adhesive small-bowel obstruction (ASBO), but this treatment has been controversial. We retrospectively reviewed 30 patients who were admitted from 1992 to 1996 because of adhesive small-bowel obstructions. METHODS: Immediate operation was reserved for the 7 patients that presented with fever and leukocytosis and /or localized abdominal tenderness or complete obstruction. The remaining 23 patients initially underwent conservative treatment. RESULTS: Although 20 episodes were cured with conservative treatment, 3 cases subsequently required surgical intervention. No adverse occurrences were observed during or after the delayed operations. Recurrence occurred in 3 cases after surgery and in 2 cases after conservative treatment. In the study, we found that the age at the recent laparotomy, the time elapsed between the recent laparotomy and the obstructive episode, and the primary condition necessitating the laparotomy correlated significantly with the success of conservative treatment. CONCLUSIONS: We conclude that in the treatment of ASBO in children, conservative treatment through the use of abdominal decompression, antibiotics, fluid-electrolytes, physical therapy, etc. has to be applied first for patients without significant evidence of strangulation and complete obstruction.